Common Ground: What Does the Far Right Get? [Or] Who Wins and Who Loses?

Jodi Jacobson

Current political debates have made "common ground" and "bipartisanship" an end in themselves, at the risk of the health and lives of real people.

This past March, I wrote an article for Rewire entitled Looking for Common Ground on Abortion? You’re Standing on It. In it, I reviewed the evidence on abortion trends in the United States–they have been declining overall—as well as the main factors leading to both unintended pregnancy and abortion in the United States.

The abortion rate in any society is a function of what are known as “proximate determinants” or “most direct” factors, and social science evidence from throughout the world underscores that the two most important proximate determinants of abortion are 1) desired number of children and 2) the rate and user-effectiveness of contraception.

If access to and effective use of contraception does not increase as the desired number of children in a society falls, there will be more abortions. Likewise, increased access to contraception will in turn reduce unintended pregnancy and the need for abortion. (To be clear, “access” is a function of a number of factors, including the economic and social costs involved in gaining access to contraceptives, and the ability to use contraception without, for example, threat of violence at the hands of an intimate partner.) Many secondary and tertiary factors of course influence the proximate determinants but at the end of the day, these two factors most directly affect unintended pregnancies and by extension abortions.

In the United States, desired family size is quite small and many women want to delay having their first child until well into their twenties. The highest rate of abortions –in the United States and abroad–occurs among those populations of women (or all ages) who want to delay, limit or space the number of children they have but who also have the least secure access to contraception and/or the least ability to control the timing or frequency of sex or the use of contraception.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Bottom line: All the public health data suggests that the most direct route to achieving the outcomes we say we desire, e.g. reducing unintended pregnancies—and by extension the need for abortion—while promoting both reproductive health and rights lies with improving access to and effective use of contraception as a key input. Not the only input, for sure, but the most important at the end of the day for those who are sexually active. This is shown to be a pattern for sexually active people across cultures.
Likewise, if we want to reduce sexually transmitted infections and achieve a range of other public health benefits, we should focus on those strategies proven by the evidence to achieve them,  including comprehensive sexual and reproductive health education (which, before the flood of comments starts please note includes but is not limited to abstinence), and access to and use of barrier methods (or dual protection where there is risk of both pregnancy and infection).

In the original article, I suggested we focus on dramatically increased funding for these proven interventions, and also suggested 9 concrete recommendations the Administration could take to use its political mandate to end the bickering over these issues and fulfill the promise made by President Obama to ensure that science and evidence would guide public policy.

In response, one frequent visitor to Rewire, DerekP, wrote a comment under the heading “Not Very Appealing,” stating:

Your idea of common ground for pro-lifers is that they should just give up and become pro-choice (and probably support government funding of abortion). That doesn’t sound very appealing.

This sentiment is echoed by other comments throughout our site and also is inherent in the opposition to increased funding for critical programs like Title X by the institutional Catholic Church, as one example.

And therein lies the dilemma in which we find ourselves in these conversations: What do “I” get? Not what women need, not what couples do and how they act, not about healthy, safe sexual lives, but what do “I/we” as representatives of vested political interests, get out of this. What do the institutional Catholic Church and Evangelical fundamentalist Christians get? What does the “pro-life” politician from a conservative district get? What do ultra conservative Representatives Chris Smith and Ileana Ros-Lehtinen get?

But what DerekP, Jodi Jacobson, Chris Smith and the United States Council of Catholic Bishops “get” is (or should be) irrelevant to the real question: What do people need? What does the evidence say? We have to start with these two concepts to achieve the outcomes we say we desire.  Otherwise we are engaging in a dangerous political contest in which the real lives of real people are at stake. If DerekP and others are interested in reducing the need for abortion, then they should live their own lives the way the feel best for them, but also be able to support the broader investments and interventions shown to result in the outcomes we all claim to seek.

What does the evidence say about how real people act, what women need in regard to primary reproductive and sexual health care, what needs to be in place to ensure women—and men–can exercise their rights? What women “need” is clear not just from what they say, but also as expressed by their actual choices or their patterns of “voting with their feet” so to speak: In the United States, one-third of all women have at least one abortion during their reproductive years, and nearly all women use some form of contraception at some point in their lifetime. Women of all religious persuasions—Catholic, evangelical, Jewish, Islamic–and all cultural backgrounds use contraception and abortion.

According to the Centers for Disease Control: 

Contraceptive use in the United States is virtually universal among women of reproductive age: 98 percent of all women who had ever had intercourse had used at least one contraceptive method. In 2002, 90 percent had ever had a partner who used the male condom, 82 percent had ever used the oral contraceptive pill, and 56 percent had ever had a partner who used withdrawal.

What women need, therefore is both access to contraception that addresses their changing needs throughout their lifecycle and access to safe abortion services. Ensuring universal access to contraception and to comprehensive sex ed, for example, will without question reduce the number of unintended pregnancies and ultimately of abortions. If these are the outcomes we seek, then we can’t let ideology drive the inputs.

Given this reality, the political demands of the (male) US Council of Catholic Bishops (among other religious institutions) should not be in the equation. At all. Especially not when even the laity of these institutions does not agree with the ideology in practice. I realize this is a controversial, even “blasphemous” suggestion if you will, but Catholic women clearly are much less squeamish about the issue than the Bishops.

It is true that I am pro-choice—I believe all people have the right to make decisions about sex and reproduction, including lifelong abstinence or consensual sex—and it is also true that I believe the pro-choice community generally represents women’s needs because the movement itself grew out of the advocacy of women and providers and advocates working on behalf of women they serve. But if we are really interested in solving the issues about which we profess to care, and if we are really interested in the health and wellbeing of people, then we should stop thinking about common ground between divergent political positions based on ideology—pro-choice, anti-choice, pro-life, Catholic, Protestant, etc–and start and end with the real needs of real people, letting evidence guide the way.

Because it is so often completely divorced from real evidence and the needs of real people, today’s common ground debate is similar to the constant talk about “bipartisanship.” “Common ground” and “bipartisanship” are political concepts and can be achieved by political entities seeking to serve their own political interests or ideologies while actually undermining public health and human rights.
Affected populations often are not even in the "room" literally or figuratively when the deals are cut.

Concrete example: In May 2003, Congress passed the President’s Emergency Plan for AIDS Relief or PEPFAR, a landmark program authorizing $15 billion for efforts to end the global AIDS epidemic around the world, with a priority focus on 15 countries in sub-Saharan Africa, Asia and the Caribbean.
PEPFAR was hailed as a “victory” for promoters of common ground, bipartisanship, and “common sense compromise.” Advocates for AIDS treatment and care secured billions of dollars destined to increase access to anti-retroviral medication (ARVs) and to care needed by those suffering from AIDS-related illnesses. The Bush Administration put a much-needed “compassionate conservative” gloss on its otherwise bellicose and disastrous foreign policy. And Congress looked good for creating a new humanitarian program with what appeared to be bipartisan support. The mainstream media fell all over itself praising the legislation.

There was only one problem. The “common ground,” “common sense” compromises reached to pass PEPFAR came at the cost of the lives of untold numbers of women and youth. In fact, from the get-go, it was made clear the achievement of a “bipartisan,” “common ground” outcome and a good political photo op was the greatest priority irrespective of the policies contained in the legislation, as long as enough money was in the pot.
In the spring of 2003, Republicans controlled both houses of Congress, so “bipartisanship” was a somewhat questionable concept to begin with.

To get buy-in from Republicans on the unprecedented levels of funding sought for AIDS treatment and care, AIDS groups needed the support of conservative evangelical and Catholic leadership. And in exchange for that support, the USCCB and evangelical political leaders led by Rick Warren sought two things: first, they wanted prevention policy to be written in such a way as to ensure it was ideologically compatible with their own religious views, and second they wanted to secure funding for their own prevention programs in the field, despite the fact that their ideological position on such intrinsically important issues as safer sex meant they would be using federal tax dollars for what would in effect be religious purposes, and not to promote public health.

This “common ground bill” resulted in women and youth being pushed off a cliff.  The law contained an earmark requiring that 33 percent of all funding for prevention programs go to abstinence-until-marriage programs, which, as a result of even narrower program guidance, resulted in the allocation of 60 percent of all funds for prevention of sexual transmission going to abstinence-only-until marriage programs in the first several years. This was true despite the fact that the highest rates of new infection were found among women and youth who were already sexually active but did not have access to prevention services, information, and methods, and the fact that a growing number of infections in women were occurring “within marriage” and to women who themselves were faithful to their husbands.

Other policies included were also based on purely ideological considerations, such as those prohibiting organizations receiving US funds from working with organizations representing the human rights of sex workers and prohibiting syringe exchange programs for intravenous drug users.

Over the 5 years following passage of PEPFAR, an overwhelming body of evidence accumulated showing these policies did not work. In fact, as a recent Stanford University study showed, after spending some $20 billion of US taxpayer funds on global AIDS programs, US funding had made no contribution to slowing the spread of HIV in the countries receiving the most funding.

Put another way: untold numbers of women and youth were needlessly infected with HIV during the period of the greatest ever expenditure on a public health problem because our “common ground” solution was to cater to ideology over evidence. So there are now more people living with HIV who were unnecessarily infected as a result of misguided, ideologically-based US policy and the majority of them will never get access to treatment.

In 2008, this grave mistake in policy was repeated when, once again, the US Council of Catholic Bishops and evangelical groups insisted on stripping out changes to these damaging policies in exchange for supporting higher levels of funding in the PEPFAR reauthorization process. Another achievement for “common ground” and “bipartisanship,” and another loss for millions of innocent people at risk of HIV, and the likely waste of billions of taxpayer dollars at a time when we are unable to provide our own citizens with decent health care.

And yet, when I ask why in common ground debates we are not starting first with filling the estimated $300 million gap in Title X funding, for example, or ensuring that we pass the Prevention First Act, or demanding full funding of comprehensive sex education, or fully funding HIV prevention initiatives, I am constantly told the “Catholics” or the “Evangelicals” won’t agree to this.  When I ask why we are not confronting these issues for the sake of people’s health and lives, I am told we don’t have to agree on everything, and when I ask why we don’t push for what we know is right, I am told, "let’s reach common ground first and we can go on and work for our own principles."

Here is a dirty little secret: I heard the exact same arguments during the PEPFAR process and many other policy debates.  But…as is usally the  case, once Congress deals with one piece of legislation on a controversial issue, it is "done."  During the first and second rounds of PEPFAR authorizations, those of us concerned about evidence-based prevention were constantly told "we’ll fix it later," but later never came. 

Later still has not arrived.  Once the bill was passed, the message changed to "PEPFAR?  Huh?  We did that already."  Let’s face it: once the press release is "released" declaring "mission accomplished" on a controversial issue there is little to no impetus for Congresspeople to go back and reopen these debates again.  "Fixing it later," or getting the policy right afterward is more myth than reality in 95 percent of the cases. 

My questions are these: Are we more interested in some so-called common ground solution to claim “victory” for political interests or are we interested in the real victory of better health, reductions in unintended pregnancies, sexually transmitted infections, and abortions that only evidence-based approaches can bring? 
Are we willing to risk the health and rights of people for an as-yet
unarticulated set of compromises that don’t address real needs?  Can we honestly say that insititutional actors whose ideological opposition to solid evidence should play a greater role in determining the lives and health of people–many of whom do not share the same religious ideology and the majority of which affiliated with the same institution do not adhere to the practices?

I know I will be called "politically naive," but I feel that to give in on the evidence before we have even fought the fight is to repeat mistakes made on PEPFAR, the recent stimulus bill, and any number of other policy issues where we either put our lowest ask on the table first without a fight or caved to conservative political pressure to once again "politicize" a public health issue. 

The only common ground that should matter is the one on which the vast majority of people in need of evidence-based sexual and reproductive health care are now standing.  Otherwise, we are standing on a precipice and the people most at risk have already been thrown off the cliff.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

071midyearstatecoveragetable

But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

071midyearstateabortionstable

In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.